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Whistleblower Case

This archive displays posts tagged as involving a whistleblower case or claim. You may also be interested in our pages:

Page 47 of 111

March 7, 2019

A landlord participating in a federally funded rent subsidy program for low-income tenants has agreed to settle allegations of violating the False Claims Act. In order to receive housing assistance funds from the Department of Housing and Urban Development (HUD), Harold Joseph Tyler of Tyler Realty Group had certified that he would not charge more rent than was agreed upon. According to a tenant who filed the qui tam complaint that launched the investigation, however, Tyler effectively charged additional rent in the form of a recurring "non-refundable deposit" of nearly $200 per month. USAO EDVA

Tagged in: FCA Federal, Housing and Mortgage Fraud, Whistleblower Case,

March 4, 2019

The CFTC announced an award of $2 million to an individual whistleblower under its Whistleblower Program. The CFTC revealed that the individual was not an insider, had provided expert analysis of market data, and received an award at least in part based on related actions brought by non-CFTC federal regulators.  As is their usual practice, the CFTC did not release further details about the case. CFTC

Tagged in: Financial and Investment Fraud, Whistleblower Case, Whistleblower Rewards,

$2.1 Million Whistleblower Settlement with Skyline Urology Resolves Allegations of Improper Unbundling Fraud

Posted  03/1/19

This week, the Department of Justice and Constantine Cannon LLP announced a $2.1 million settlement against Skyline Urology, at one time the largest urology practice in California. The settlement, which includes $1.85 million to the United States and $250,000 to the State of California, resolved allegations by our whistleblower client that Skyline had engaged in a systematic coding scheme to defraud Medicare and...

Tagged in: Bundling and Unbundling, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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Constantine Cannon LLP Announces $2.1 Million Whistleblower Settlement with Skyline Urology

Posted  02/28/19

Settlement resolves whistleblower client’s allegations of systematic coding scheme to improperly increase reimbursement.

WASHINGTON, D.C. February 28, 2019 -- Constantine Cannon LLP is pleased to announce that its whistleblower client’s claims resulted in a $2.1 million settlement against Skyline Urology, a major medical practice in California. The whistleblower exposed an alleged systematic coding scheme to...

Tagged in: Bundling and Unbundling, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

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February 25, 2019

Skyline Urology will pay $1.85 million to resolve allegations under the federal False Claims Act that it improperly billed Medicare for evaluation and management (E&M) services that did not meet the criteria for separate billing.  Skyline allegedly used "Modifier 25" to unbundle its E&M billing even when the E&M services were provided on the same day as other billed medical services and were not significant, separately identifiable, and beyond those ordinarily involved with the associated procedure.  A whistleblower, James M. Cesare, filed a qui tam complaint, and will receive a relator's share of approximately $323,750.  DOJ

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

Data Whistleblower Case Raises Question of What is a Public Disclosure

Posted  02/21/19
Rows of chairs with people waiting in hospital billing office
As regular readers know, we have been closely tracking the progress of data analysis firm Integra Med Analytics’ whistleblower lawsuit under the False Claims Act against Providence Health and its consultant J.A. Thomas and Associates, Inc. (JATA).  The case alleges a conspiracy between Providence and JATA to upcode for specific Major Complications or Comorbidities (MCCs). This case is part of a growing number of...

Tagged in: Court Decision, FCA Federal, Healthcare Fraud, Hospital Fraud, Public Disclosure and Public Information, Upcoding, Whistleblower Case,

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February 14, 2019

Compounding pharmacy Vital Life Institute LLC, formerly known as AgeVital Pharmacy LLC, will pay $775,000 to resolve claims that the company and its principals paid kickbacks to third-party marketing companies to solicit prospective patients, regardless of the patients' needs.  The investigation was initiated by the filing of a qui tam complaint under the False Claims Act by Manfred Knopf, who received unwanted compounded medications from AgeVital that were billed to Medicare.  Mr. Knopf will receive $139,500 as a whistleblower reward.  DOJ

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Pharma Fraud, Whistleblower Case, Whistleblower Eligibility, Whistleblower Rewards,

February 14, 2019

Prime Healthcare Services and its CEO Prem Reddy, will pay $1.25 million to settle claims under the False Claims Act that two Prime Healthcare hospitals in Pennsylvania, Roxborough Memorial Hospital and Lower Bucks Hospital, billed Medicare for patients who were admitted when they could have been treated on an outpatient basis, and up-coded patient diagnoses to increase Medicare payments.  The investigation was initiated by an anonymous whistleblower identified as a former employee of the Roxborough hospital.  USAO ED PA

Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Upcoding, Whistleblower Case,

February 11, 2019

GenomeDx Biosciences Corp. has agreed to pay $1.99 million in connection with a whistleblower complaint by two former employees, which alleged that the genetic testing laboratory violated the False Claims Act in its submissions to Medicare. According to the unnamed whistleblowers, from 2015 to 2017, GenomeDx submitted reimbursement claims for running a post-operative genetic test on prostate cancer patients, even though that population did not have risk factors that called for the test. They will share in a $348,316.50 award as part of the settlement. USAO SDCA

Tagged in: FCA Federal, Healthcare Fraud, Laboratory and IDTF, Medicare, Whistleblower Case,

February 11, 2019

North Greenville University (NGU) in South Carolina has agreed to pay $2.5 million to settle claims that it violated Title IV of the Higher Education Act, as well as the False Claims Act, by improperly compensating student recruiters with bonuses while receiving federal student aid. The alleged fraud was exposed by Maurice Shoe, co-owner of a recruiting company partially owned by NGU; Shoe will now receive $375,000 of the government’s recovery. DOJ

Tagged in: Education Fraud, FCA Federal, Whistleblower Case, Whistleblower Rewards,

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